Saying they wanted to rethink the more than $250 billion in Medicare spending cuts included in their fiscal plans, Senate Republicans last week delayed the start of federal budget deliberations until at least next week.
On the House side, provider groups that have met recently with House Budget Committee staff said that Budget Committee Chairman John Kasich (R-Ohio) would propose more than $300 billion in reductions to projected Medicare spending over the next seven years. Kasich is expected to release his budget proposal next week.
According to the Congressional Budget Office, Medicare is expected to grow by about 10% per year, reaching a projected $262 billion in spending by the year 2002. If the savings being proposed by House Republicans were enacted, the Medicare spending growth rate would decrease to about 7%, according to staff projections.
As the release of the budget has grown nearer, Republicans in both the Senate and House have increasingly felt pressure from provider and senior groups. Senate Republicans also have been unable to come to an agreement among themselves.
Republican presidential candidate Sen. Phil Gramm of Texas has promised to vote against any budget that does not include a tax cut, while Senate Budget Committee Chairman Pete Domenici (R-N.M.) and Senate Finance Committee Chairman Bob Packwood (R-Ore.) have come out against a tax cut.
Last week, Domenici said he would propose "enforceable" spending caps for Medicare and Medicaid. Such caps could be enforced through a panel that would review the spending limits and adjust benefits to fit under the cap.
The American Hospital Association has been calling for such a commission to review Medicare benefits. Under the AHA plan, Congress would be forced to accept or reject the commission's recommendations in total.
Provider groups also have been pressing congressional Republicans to "back load" any Medicare spending reductions that hit providers. Because the budget will cover a seven-year period, provider groups are pushing to have their portion of the reductions moved to the later years, when the effects of moving more Medicare beneficiaries to managed care would begin to take effect.
Meanwhile, representatives of several major provider groups were scheduled to meet with White House officials late last week. The Clinton administration called the meeting to discuss strategies to deflect Republican attempts to make deep cuts in Medicare and Medi-caid spending.
Among the expected participants were the American Hospital Association, the Catholic Health Association and the National Association of Public Hospitals.